A NEW FIVE POINT MODEL OF MIDWIFERY CARE ENABLES FASTER AND SAFER BIRTHS, LOW
CESAREAN SECTION RATES, AND WONDERFUL BIRTH EXPERIENCES.
Donna Tabas, CNM, M.S.
North Jersey Midwifery Care, L.L.C.
Donna Tabas, CNM, M.S., a Columbia University trained Certified Nurse Midwife and the Owner and Founder of North Jersey Midwifery Care, L. L.C. that serves the women of Bergen and Hudson Counties in New Jersey and Rockland County and New York City in New York has developed a new five point model of midwifery care for low risk women that has resulted in faster natural labors in both first time and repeat birthing mothers, low Cesarean section rates, wonderful birth experiences and excellent outcomes. Although many midwifery practices offer some components of her care model, Donna, with 32 years of experience working with birthing families, and a solo, “dedicated” midwife, has discovered that simultaneously combining all five components of this unique care model enables, in the safety of the hospital setting, the excellent, safe, fast, and empowering birthing outcomes that the women under her care experience, with an extremely low Caesarean Section Rate. Using this model eliminates the “Necessary Unnecessary Caesarean Sections.”
“This 5 point model of care is informed by her number one priority of a birth culminating in a healthy baby and a healthy mother, which she believes is facilitated by the motto, “Natural facilitates safety, but safety alwaystrumps natural.”
These five points of care for low risk women combines:
1) Extraordinarily personalized, unrushed home prenatal care. Although Donna does have an office in Union City, NJ, she offers (and prefers) to come to the woman’s own home (in her “Pregnancy Mobile”) for each unrushed, extended time prenatal visit with no time limits, which can be as short or long as the woman desires. As an up-to-date clinician she provides state of the art, evidenced-based standards of maternity care (which she refers to as “dipstick and measure” care). However, Donna Tabas, CNM, understands that pregnant women “are not just uteri walking around with legs,” and that birthing is “5% plumbing and 95% head and heart.” Her holistic model of care allows for all issues and questions to be explored in a sensitive, delicate, and spontaneous manner in ways that are just not possible in the more typical 15 minute prenatal appointments. Working on these revealed issues often impact ways that will facilitate a more normal birth. In addition, this unrushed, home-based atmosphere allows for the kind of trusting relationship to develop that is so crucial to a pregnant woman, her midwife, and ultimately her birth process.
2) Exposure to Hypnobirthing and discussions that transform the expectations of normal birth from that of fear, tension and pain, to that of power, relaxation, confidence, and comfort. Donna becomes the protective guardian of the birthing space to allow this transformation to unfold. In our culture, the medicalization of birth has created an expectation that birth will be extraordinarily painful, frightening andintolerable. These expectations can create an experience that will be infused with fear, tension, and pain (FTP). This FTP cycle releases stress hormones which stops the normal flow of oxytocin, the “Love Hormone,” that mediates both lovemaking and labor, and necessitates the need for a pharmacologically augmented labor with Pitocin. Pitocin requires continuous monitoring and is more painful; therefore a birthing woman may very well request/need an epidural which begins a cascade of medical interventions that lead us away from the normal, physiological model of birth (see below), and closer to the associated high rates of Cesarean Sections (30-40%) currently in our country. Actually, normal, undisturbed physiological birth does not need to be scary, fearful, or extraordinarily painful at all! To birth our babies normally, the birth environment should be similar to the same environment in which we need to conceive a baby--feeling safe, unthreatened, trusting, and private. Over the course of the nine months of prenatal care, through the use of Hypnobirthing and other relaxation techniques, Donna Tabas, CNM, slowly helps her women take any negative preconceived notions about childbirth that may be based on negativity and fear, and transforms their expectations of the natural birthing process to one of power, strength, relaxation, and confidence. This technique is what facilitates having the faster labors that the women Donna attends do have. To facilitate that sense of safety, trust, and privacy, Donna guards, maintains, and preserves the woman’s birthing environment to optimize a birthing woman’s state of relaxation and decrease her stress, to enable a birthing woman to have a more natural, physiological birth.
(3) Doula care in labor for all her women. In addition to being attended by a midwife and perhaps the woman’s partner, doula care is a crucial component of this midwifery model. A doula is usually a professionally trained woman who has attended many births and has a whole repertoire of ways to assist birthing women. The doula is there in a supportive role to facilitate comfort, relaxation, coping techniques, position changes, and physically, emotionally, and/or spiritually support the birthing couple. Having a doula will ensure that the laboring woman has the continuous one-on-one support she needs by someone whose only role it is to assist with coping with labor without interruptions. Using a doula has been consistently documented by several good quality research studies to decrease Cesarean section rates, decrease the use of pain medications and epidurals, help the birthing woman to remain relaxed without fear, and help to achieve healthier birth outcomes.
(4) Guiding and maintaining the birth as normal using the natural physiological model of birth, as opposed to the medical model of birth. Midwives say, “If you can’t move the mother, you can’t move the baby!” The physiological model of birth includes complete maternal mobility, having the woman eat and drink lightly during labor, and allows her unmedicated body to naturally assume the positions that will help the baby journey out of the pelvis. She will push her baby out in whatever position feels right for her, which allows for less perineal injury. Putting the baby skin to skin on mom’s abdomen immediately after birth assists the baby’s transition to life outside the womb more gently, allows for perfect temperature control, and enables the baby to acquire the needed microbiomes it needs from its mother. This skin-to-skin contact facilitates the hormones that help the placenta to be born safely, and facilitates bonding and breastfeeding. Using delayed cord clamping allows the baby to get an extra 1/3 of its blood , helps facilitate the baby’s transition to becoming air dependent, reduces neonatal problems, and results in lower rates of anemia at six months of age. Waiting patiently for the placenta to be expelled gently with physiological help from the natural oxytocin that is released during this bonding time while mother and baby are still together reduces the rate of postpartum hemorrhages. Donna is expertly trained as a midwife to keep births more normal or recognize when there are any problems that may require the benefits of modern medical intervention and consultation with an OB/Gyn. But “If it isn’t broken, don’t mess with it!” Birth outcomes are safer and better if birth is left as undisturbed as possible with the appropriate monitoring for safety.
(5) Donna Tabas, CNM, is a solo “dedicated” midwife, meaning that she is the only midwife that her women will have for all their prenatal care, the birth, and postpartum period, barring extraordinary circumstances (death in family, illness, etc.), and will be present throughout the whole labor and birth process. This reassurance of the presence of the midwife the woman has chosen and with whom she has developed this trusting bond is crucial to feeling comfortable and safe, promoting a more physiological birth. Donna’s continuous presence during the active stage of labor allows her to diagnose and correct problems that might develop in birth, such as malpositioned babies, which, if uncorrected, often do not fit through the pelvis in that position and may not be
able to be born vaginally. Uncorrected malpositioned babies (i.e. posteriors) compose a large component of the high Cesarean Section rates now in our country (30-40 %.) By simply being there at the right time and knowing how to rotate the baby into a more favorable position can restore a birth to one of normality, and avoid a Cesarean Section for “failure to progress or descend,” which ends up being the “Necessary Unnecessary Cesareans” that Donna’s Five Point Model of care tries to prevent.
Donna Tabas, CNM, wants each woman, as she approaches her Birthing Day, to feel confident, prepared, relaxed, and ready to fully experience all the sensations of labor without fear, and birth with power, strength and joy.